This dissertation reports on five of the eight studies of the project named Interactive Tool for Self-management through Lifestyle Feedback (It’s LiFe!). This tool aims to support chronically ill patients in achieving a more active lifestyle. The first study of this dissertation includes the development of a physical activity counselling protocol for practice nurses to support self-management of patients with COPD or type 2 diabetes (DM2) who are treated in primary care. The second study describes the development and testing of a Web-based coaching system as part of the tool (the It’s LiFe! monitor). In the third study the feasibility of the tool and the monitor embedded in the counselling protocol named the Self-management Support Programme (SSP) was evaluated in two family practices. The fourth study, in 24 family practices, describes the effectiveness of this counselling protocol with and without the use of the tool and monitor on physical activity, (exercise) self-efficacy and quality of life. Finally, the fifth study describes the process evaluation that was conducted to examine the reach and implementation of, and satisfaction with, this intervention .
The combined intervention (use of the tool + the SSP) led to a significant improvement of moderate to vigorous physical activity, compared to usual care. Right after the intervention period, the progress was 12 minutes per day. Three months after the intervention period, this progress was still significant (11 minutes). The trial also proved that use of the tool on top of the SSP is more effective than the SSP only (an additional eight minutes). The SSP alone had no significant effect on physical activity compared to usual care. For the secondary outcome measures the intervention effect was not evident. From these results it can be concluded that the automated self-monitoring and feedback component and/or the fact that the practice nurse was able to see the objectively measured physical activity results were the most powerful elements of the combined intervention.